|Year : 2015 | Volume
| Issue : 2 | Page : 122-127
Impact of perinatal oral health care education programme on the knowledge, attitude and practice behavior amongst gynaecologists of Vadodara city
Anshula Neeraj Deshpande, Steffi Jasbir Dhillon, Koodakandi Somanna Poonacha, Bhavna Harish Dave, Prriya Arun Porwal, Chirag Samuel Macwan
Department of Paedodontics and Preventive Dentistry, K. M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
|Date of Web Publication||15-Apr-2015|
Dr. Steffi Jasbir Dhillon
Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College, Vadodara-391760, Gujarat
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Context: Gynecologists the Primary Health Care providers, for pregnant mothers bear the unique responsibility to detect and diagnose oral health problems for timely and effective interventions. Aim: The aim of the study was to assess the impact of Perinatal Oral Health Care (POHC) education program on the knowledge, attitude and practice behavior amongst Gynaecologists of Vadodara City. Settings and Design: An analytical cross sectional study was conducted amongst Gynecologists practicing in Vadodara city, registered under Indian Medical Association (IMA), Baroda, Gujarat. Materials and Methods: A validated questionnaire survey was conducted to establish a baseline level of knowledge, attitude and practice behavior of 46 Gynecologists. After that education and awareness regarding POHC to Gynecologists was provided with the help of flip charts and resource brochures. To determine the impact of recent provision of education and awareness a post-test was conducted. Statistical analysis used: Data was analyzed by paired t-test using the SPSS Version 20. Results: The results after evaluating the data from pretest and posttest showed a mean increase of correct answers in knowledge (from 7.304-9.891; P = 0.00), Attitude (from 3.978-4.108; P = 0.49) and practice behavior (from 4.130-5.521; P = 0.00) in POHC amongst Gynecologists following the education program. Conclusions: It can be concluded that there is a need for provision of education and awareness to the primary health care providers which would help in improving pregnant women and infant's oral health status along with establishment of dental home.
Keywords: Dental home, gynaecologists, perinatal oral health care
|How to cite this article:|
Deshpande AN, Dhillon SJ, Poonacha KS, Dave BH, Porwal PA, Macwan CS. Impact of perinatal oral health care education programme on the knowledge, attitude and practice behavior amongst gynaecologists of Vadodara city. J Indian Soc Pedod Prev Dent 2015;33:122-7
|How to cite this URL:|
Deshpande AN, Dhillon SJ, Poonacha KS, Dave BH, Porwal PA, Macwan CS. Impact of perinatal oral health care education programme on the knowledge, attitude and practice behavior amongst gynaecologists of Vadodara city. J Indian Soc Pedod Prev Dent [serial online] 2015 [cited 2019 Sep 21];33:122-7. Available from: http://www.jisppd.com/text.asp?2015/33/2/122/155124
| Introduction|| |
Perinatal oral health plays a crucial role in overall health and well-being of pregnant women and their newborn child. , The perinatal period is defined as the period around the time of birth, beginning with the completion of the 20-28 th week of gestation and ending 1-4 weeks after birth.  Many women do not seek dental care during their pregnancy. , It has been found that periodontal disease may be associated with adverse pregnancy outcomes in humans such as preterm deliveries, low birth weight babies, and preeclampsia. 
Mothers with increased cariogenic oral bacteria are at greater risk for infecting their children at early age. , Determining those mothers at highest risk for transferring cariogenic bacteria to their children improves opportunities for preventive intervention. The primary goal of perinatal oral health care (POHC), with regard to caries transmission, is to lower the numbers of cariogenic bacteria in an expectant mother's mouth so that mutans streptococci (MS) colonization of the infant can be delayed as long as possible. 
Timely delivery of educational information and preventive therapies to these parents can reduce the incidence of early childhood caries (ECC), prevent the need for dental rehabilitation, and improve the oral health of their children. , Many expectant mothers are unaware of the implications of poor oral health for themselves, their pregnancy, and/or their unborn child hence it becomes necessary for the Gynecologist who are more likely to see expectant or new mothers and their infants to be more aware of the various adverse effects of poor oral health. Hence, this study was conducted to assess the impact of POHC education program on the knowledge, attitude and practice behavior amongst Gynecologists of Vadodara City.
| Materials and Methods|| |
The study protocol was assessed and approved by the institutional review board of K.M. Shah Dental College, Vadodara, Gujarat, India and ethical clearance was taken from institutional ethics committee, Sumandeep Vidyapeeth (approval number SVIEC/ON/Dent/SRP/13280). An analytical cross sectional study was conducted to assess the impact of POHC education program on the knowledge, attitude and practice behavior amongst Gynecologists of Vadodara City, Gujarat. The list of all the Gynecologists practicing in Vadodara City and registered in Medical Association Baroda, was obtained from www.barodamedicalguide.com.
The investigation was performed between June 2013 to August 2013, and 48 Gynecologists participated in the study with 95% confidence interval (CI) and 20% relative error (RE) which was derived on the assumption of proportion of true knowledge among respondents from the pilot study. Simple random sampling method was used to select the participants for the study.
- Gynecologists practicing in Vadodara City, registered in Medical Association, Baroda, Gujarat were included.
- Gynecologists who refuse to give informed written consent.
- Gynecologists who could not be contacted on three subsequent visits.
- Gynecologists who did not fill the questionnaire.
Prior appointment and the schedule for the study were obtained from the participants. A 21 items, closed ended, questionnaire was prepared with help of experts that included 11 questions testing knowledge, five questions testing attitude and five questions testing practice behavior regarding POHC. The concurrent and content validity of given questionnaire was pre-tested by carrying out a pilot study. Questionnaire to the participants was delivered in person.
In the first visit pretest was performed with the participants filling the questionnaire. It was followed by provision of education and awareness regarding POHC by the means of flip chart [Figure 1] and resource brochures [Figure 2] a and b] that were prepared reviewing the literature. After 1 month during the second visit, post test was conducted to evaluate the effect of intervention using the same questionnaire. Out of 48 Gynecologists, two of them did not return the post test questionnaire so only 46 of them were included in the study. Data collected were statistically analyzed using the SPSS version 20. Paired t-test was used for comparison of data between both the groups with statistically significant level set at P ≤ 0.05.
|Figure 1: Flip chart used for the provision of education and awareness regarding perinatal oral health to Gynaecologists|
Click here to view
|Figure 2: (a, b) Resource brochure used for delivering education regarding perinatal oral health to Gynaecologists|
Click here to view
| Results|| |
A total of 46 Gynecologists that were included in the study, of which 34 had M.D. degree, eight had a D.G.O degree and four had both the above degrees.
Sample distribution work experience wise
Fourteen of the respondents had more than 25 years of work experience, 22 of the respondents had experience between 10-25 years and 10 of them had the experience of less than 10 years with the mean age of experience of the respondents being 10-25 years.
Difference in knowledge of the respondents
It was found that there was a statistically significant (P value = 0.00) improvement in knowledge of the Gynecologists regarding POHC based on the mean percent correct answers between the pre- and post-intervention data. The mean of correct answers regarding knowledge increased from 7.304-9.891 after delivering education regarding POHC [Table 1].
|Table 1: Results of correct knowledge regarding POHC amongst Gynecologists before and after delivering education and paired t-Test for comparison between pre test and post test situation|
Click here to view
Difference in attitude of the respondents
It was found that there was an improvement in attitude of the Gynecologists regarding POHC which was not statistically significant (P value = 0.49) based on the mean percent correct answers between the pre- and post-intervention data but an increase in mean correct answers was seen from 3.978-4.108 [Table 2].
|Table 2: Results of correct attitude regarding POHC amongst Gynecologists before and after delivering education and paired t-Test for comparison between pre test and post test situation|
Click here to view
Difference in practice behaviour of the respondents:
It was found that there was a statistically significant (P value = 0.00) improvement in practice behavior of the Gynecologists regarding POHC based on the mean percent correct answers between the pre- and post-intervention data as the mean correct answers increased from 4.130-5.521 [Table 3].
|Table 3: Results of correct Practicing behavior regarding POHC amongst Gynecologists before and after delivering education and paired t-Test for comparison between pre test and post test situation|
Click here to view
| Discussion|| |
Very few studies have been done to evaluate the effect of health awareness programs amongst health professionals and the present research is one of a kind in which the evaluation of POHC awareness program on the knowledge, attitude and practice behavior amongst Gynecologists is done. Previous study done by Baseer MA et al., has shown a meager level of awareness regarding oral health for pregnant women amongst Gynecologists who are the first to see and provide total medical care and advice to the pregnant woman.  Previous study by Zanata et al., evaluated oral health care among Brazilian gynecologists and observed that their knowledge is limited and it is not consistent with established guidelines.  Similarly, Rocha et al., concluded that obstetricians were aware of the association between gingival inflammation and adverse obstetric outcomes but their attitudes were not in agreement with apparent knowledge of periodontal diseases and its possible impacts.  Results of the study done by Shah et al., are in contrast with the above studies.  Various studies have indicated a need for updating the health care professionals regarding POHC. ,,,
In the present study 70% of mean correct response is considered as a set point as we expect that much amount of learning during their under graduate and post graduate program and as a professional the mean age of experience of the respondents were above 10 years.
The results of correct knowledge regarding POHC amongst Gynecologists before delivering education were observed below par (<70%) as far as following questions are concerned:
- Active periodontitis affect fetus growth/ pregnancy outcomes.
- Periodontal disease during pregnancy affect labor.
- Prevalence and severity of dental caries in pregnant women affect caries prevalence in the child.
- Use of inhalation anesthesia during pregnancy to carry out dental treatment.
- Diagnostic dental X-ray can be taken during pregnancy.
Since the above set of questions asks for compatible knowledge of dentistry as good as a practicing dentist of a specialist stature, one could expect a little lesser knowledge from a standard practicing Gynecologist. However, every practicing Gynecologist ought to possess captioned knowledge.
The results of correct knowledge regarding POHC amongst Gynecologists before delivering education were observed above par (>70%) as far as following questions are concerned:
- Hormonal changes during pregnancy hinder the body's ability for repair of soft tissue.
- Can dental treatment be provided during pregnancy.
- Can amalgam restorations be provided during pregnancy.
- Antibiotic of choice for treatment of dental infection in pregnant women.
- Analgesic of choice for treatment of dental infection in pregnant women.
- Use of local anesthesia during pregnancy to carry out dental treatment.
It seems that the above set of questions has similar content of the curriculum which they have studied and it also overlaps with the present study under reference, resulting thereby, exhibiting satisfactory knowledge levels that is above par (>70%).
It is worth mentioning that the results of correct knowledge regarding POHC amongst Gynecologists after delivering education were remarkable as the mean correct response increased from 7.30-9.89 which exhibited their great sense of acquiring knowledge. In the study done by Baseer MA et al., too the Gynecologists had expressed their need for further information regarding the prevention of oral diseases. 
The results of correct attitude regarding POHC amongst Gynecologists before delivering education were observed below par (<70%) as far as following questions are concerned:
- Satisfaction with the knowledge regarding POHC.
- Not providing service of POHC because of lack of demand is justifiable.
- Not providing service of POHC because of lack of time is justifiable.
This exhibition of level of attitude below par is perhaps due to the fact that the community of Gynecologists does not understand the impact and importance of perinatal dental care over the health of pregnant woman and subsequently their new born child.
The results of correct attitude regarding POHC amongst Gynecologists before delivering education were observed above par (> 70%) as far as following questions are concerned:
- Oral health care to be included as a part of prenatal care.
- POHC counselling to be provided to pregnant women.
The community of Gynecologists seems to be convinced for the above set of questions. The results of correct attitude regarding POHC amongst Gynecologists after delivering education and intervention were not statistically significant yet there were traces of improvement in their attitudes.
The human minds are mostly adverse to adopt any change, this can be substantiated by the statements of some of the respondents from the captioned sample:
"We deal with two completely different areas of the body, how perinatal oral health care and adverse pregnancy outcomes can be associated."
"Really! Is it? I will have to google it up."
"No, I don't think so what you are saying is correct."
"Please mail me the evidence and articles regarding this topic."
According to a study done by Alves RT et al., health care providers' attitudes regarding pregnant women's oral health were related to their occupation, qualification, and dedication to the public service and this fact is supported by the results of his study where dentists had more favorable attitude than the Obstetrician/Gynecologists and nurses.  It has been recommended by Lamster IB et al., that communication among health professionals themselves, as well as with patients is a key attitude towards health promotion.  In the present study too, the constructive outcome of the established communication by the dentist with Gynecologists is seen by the increase in mean correct response from 3.978-4.108.
The results of correct practice behavior regarding POHC amongst Gynecologists before delivering education were observed below par (<70%) as far as following questions are concerned:
- Performing oral examination of the pregnant women.
- Examining the oral cavity by which method.
- The preferable time period to get the treatment done in patients requiring dental treatment.
- Asking them to regularly floss their teeth.
- Asking them to use mouth rinse.
Since Gynecologists are not well-versed with the affect of periodontal diseases on adverse pregnancy outcomes, they, generally, do not perform POHC examination. On the contrary, they prefer to refer the patients to the dentist/pedodontist only if the patient complains of any dental problem. This is in accordance with the findings of the study done by Zanata et al., as well as Menoli APV et al. , Barriers to Prenatal oral health education reported by Curtis M et al., are too few pregnant patients in clinical settings for responding dental schools and lack of faculty expertise for responding Obstetrics & Gynecology residencies. 
The results of correct practice behavior regarding POHC amongst Gynecologists before delivering education were observed above par (>70%) as far as following questions are concerned:
- Referring the patients requiring treatment to the Dentist/Pedodontist.
- Asking them to regularly brush their teeth.
Perhaps the above set of questions is of very ordinary and basic nature, therefore automatically it gets looked after.
The results of correct practice behavior regarding POHC amongst Gynecologists after delivering education and intervention has produced statistically significant improvement and made them more serious and responsible regarding the captioned issue. This indicates extremely receptive behavior of these health care professionals and the effectiveness of audio visual education delivering methods that is flip charts and brochures on POHC. Various other studies have also found such modality of delivering education to be effective. ,,, One of the respondents really appreciated this effort of generating POHC awareness by saying that, "This is a very interesting topic chosen by the investigators, keep it up." Bates SB et al., in their study have found that social media can effectively provide dental health messages during pregnancy. 
Small sample size was the limitation of the present study. It can be concluded from results of the present study that the baseline level of knowledge in the areas that were not included as a part of the academic curriculum were inadequate which led to lame attitude and incorrect practice behavior regarding POHC. After the intervention by provision of POHC education prove to be effective in adding as well as successfully stimulating the hunger center for more knowledge and leading to refinement of attitude along with practice behavior amongst Gynecologists.
The following future recommendations are proposed based on the findings of the present study; firstly, to update the knowledge; continuous education program should be conducted. Secondly, for the future professionals; information regarding oral health care should be included as a part of their curriculum and thirdly, all this would facilitate the establishment of dental home for the infants. If the above stated recommendations are followed than it could be of great use in the continual improvement of POHC.
| References|| |
Gaffield ML, Gilbert BJ, Malvitz DM, Romaguera R. Oral Health during pregnancy: An analysis of information collected by the pregnancy risk assessment monitoring system. J Am Dent Assoc 2001;132:1009-16.
Keirse MJ, Plutzer K. Women's attitudes to and perceptions of oral health and dental care during pregnancy. J Perinat Med 2010;38:3-8.
Dasanayake AP, Gennaro S, Hendricks-Munoz KD, Chhun N. Maternal periodontal disease, pregnancy, and neonatal outcomes. MCN Am J Matern Child Nurs 2008;33:45-9.
Fadavi S, Sevandal MC, Koerber A, Punwani I. Survey of oral health knowledge and behavior of pregnant minority adolescents. Pediatr Dent 2009;31:405-8.
Ramos-Gomez FJ, Weintraub JA, Gansky SA, Hoover CI, Featherstone JD. Bacterial, behavioral and environmental factors associated with early childhood caries. J Clin Pediatr Dent 2002;26:165-73.
Patil S, Thakur R, Madhu K, Paul ST, Gadicherla P. Oral health coalition: Knowledge, attitude, practice behaviours among gynaecologists and dental practitioners. J Int Oral Health 2013;5:8-15.
Hale KJ; American Academy of Pediatrics. Policy on oral health risk assessment timing and establishment of the dental home. Pediatrics 2003;111:1113-6.
Lucey SM. Oral health promotion initiated during pregnancy successful in reducing early childhood caries. Evid Based Dent 2009;10:100-1.
Plutzer K, Spencer AJ. Efficacy of an oral health promotion intervention in the prevention of early childhood caries. Community Dent Oral Epidemiol 2008;36:335-46.
Baseer MA, Rahman G, Asa'ad F, Alamoudi F, Albluwi F. Knowledge, attitude and practices of gynecologists regarding the prevention of oral diseases in Riyadh city, Saudi Arabia. Oral Health Dent Manag 2014;13:97-102.
Zanata RL, Fernandes KB, Navarro PS. Prenatal dental care: Evaluation of professional knowledge of obstetricians and dentists in the cities of Londrina/PR and Bauru/SP, Brazil, 2004. J Appl Oral Sci 2008;16:194-200.
Rocha JM, Chaves VR, Urbanetz AA, Baldissera Rdos S, Rosing CK. Obstetrician's knowledge of periodontal disease as a potential risk factor for preterm delivery and low birth weight. Braz Oral Res 2011;25:248-54.
Shah HG, Ajithkrishnan C, Sodani V, Chaudhary NJ. Knowledge, attitude and practices among Gynecologists regarding Oral Health of expectant mothers of Vadodara City, Gujarat. Int J Health Sci (Qassim) 2013;7:136-40.
Habashneh R, Aljundi SH, Alwaeli HA. Survey of medical doctors' attitudes and knowledge of the association between oral health and pregnancy outcomes. Int J Dent Hyg 2008;6:214-20.
George A, Shamim BN, Johnson RN, Dahlen BN, Ajwani S, Bhole S, et al
. How do dental and prenatal care practitioners perceive dental care during pregnancy? Current evidence and implications. Birth 2012;39:238-47.
Reddy RS, Amara SL, Tatapudi R, Koppolu P, Nimma VL, Reddy RL. Awareness and attitude towards maintenance of oral health during pregnancy among patients and clinicians attending obstetrics and gynecology ward. J NTR Univ Health Sci 2013;2:102-8.
Alves RT, Ribeiro RA, Costa LR, Leles CR, Freire Mdo C, Paiva SM. Oral care during pregnancy: Attitudes of Brazilian public health professionals. Int J Environ Res Public Health 2012;9:3454-64.
Lamster IB, DePaola DP, Oppermann RV, Papapanou PN, Wilder RS. The relationship of periodontal disease to diseases and disorders at distant sites: Communication to health care professionals and patients. J Am Dent Assoc 2008;139:1389-97.
Menoli AP, Frossard WT. Profile medical gynecologists/obstetricians Londrina regarding oral health of pregnant women. Semina 1997;18:34-42.
Curtis M, Silk HJ, Savageau JA. Prenatal oral health education in U.S. dental schools and obstetrics and gynecology residencies. J Dent Educ 2013;77:1461-8.
Goel P, Sehgal M, Mittal R. Evaluating the effectiveness of school-based dental health education program among children of different socioeconomic groups. J Indian Soc Pedod Prev Dent 2005;23:131-3.
Otchere DF, Leake JL, Lee AJ. Evaluation of the effectiveness of the Toronto Dental Education Programme. J Dent Res 1988;67:192.
Cardenas LM, Ross DD. Effects of an oral health education program for pregnant women. J Tenn Dent Assoc 2010;90:23-6.
Bates BS, Riedy CA. Changing knowledge and beliefs through an oral health pregnancy message. J Public Health Dent 2012;72:104-11.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]